On TV and in the movies, EMTs are usually portrayed at the most dramatic moments in their jobs. But what is a shift really like for a firefighter/emergency medical technician?
We turned to the Tucson Fire Department to find out.
By Elena Acoba | Photography by Shelley Welander
In 2017, the Tucson Fire Department dispatched medical emergency responders 72,138 times. That accounted for 78 percent of more than 92,000 emergency calls to the department.
All TFD firefighters get 150 to 190 hours of training as EMTs. They learn how to assess medical and trauma issues, take vital signs and provide basic life support (BLS) such as emergency wound and trauma care and giving oxygen and some medications.
Paramedics take at least 1,000 hours of training, including classes in anatomy and physiology. That allows them to provide advanced life support (ALS), including using a heart monitor, administering multiple medications, performing advanced airway procedures and transporting patients to hospital emergency rooms.
Sometimes EMTs will perform the same treatments as paramedics in extreme circumstances when a paramedic isn’t available, such as in rural areas.
One shift with firefighter/emergency medical technician (EMT) Cam Welander early this year showed the variety of calls that require medical help, from true emergencies to non-critical first-aid advice.
Welander’s day at Station 4 near Grant Road and Interstate 10 starts with station upkeep and exercising. Two hours later he responds to the first call of the day: A man who fainted in a doctor’s office.
He and two other firefighters take the ladder truck to the office, lights and sirens on. The older man with several chronic health issues is conscious when the crew arrives. Using their own equipment, the firefighters determine that his blood pressure and pulse are normal, both as he is seated and when he stands up.
Asked what he’d like to do, the patient opts to go home. The firefighters caution him to seek medical help if he continues to feel bad.
Welander, who has logged 12 years as a firefighter, puts in an 8 a.m. to 5 p.m. “work” day to train, keep up on professional news, read and act on memos, drill and maintain the station and equipment. Although every firefighter is an EMT, Welander is designated at his station to make sure that stores are stocked with medical supplies and that medical emergency equipment is functioning.
A mid-afternoon call sends him, the rest of the ladder crew and the paramedic truck with two more firefighters to check on an unresponsive woman. They find an underweight 30-year-old breathing at a rate of six breaths per minute — the normal is 12 to 18 — with an elevated pulse and low blood oxygen.
They administer oxygen and help with ventilation using a bag-valve mask, also called a manual resuscitator, which is enough for her to “sort of” come to, Welander says.
“She didn’t look healthy. She was super skinny,” he adds. “The whole way she presented herself, she ended up being transported in advanced life support with the medics.” That means a ride to the hospital emergency room. On the way, information about the woman’s condition is transmitted to the ER by computer to prepare hospital staff for her arrival.
Medical emergency responders are guided by directives issued by Dr. Terrence Valenzuela, an emergency room physician with Banner — University Medical Center Tucson who also serves as the TFD medical director.
Instead of getting on the radio to get direction from hospital ER personnel, “we function under what is called administrative guidelines,” says TFD Capt. Julian Herrera, who is in charge of medical administration. That saves time and it standardizes how responders handle calls.
Firefighters drill on these directives and use them to quickly assess each situation.
For the unconscious woman, the team checked multiple vital signs, including blood pressure, heart rate, pupils, gripping and skin elasticity. They noted the circumstances—in this case, the patient was lying down with low respiration rate — and took a quick medical history.
“We trust our numbers and the way the patient is presenting,” says Welander. “Based on what we find, we have guidelines that specify whether the patient needs to be transported in an ALS or basic life support ambulance.”
After 5 p.m., Welander’s work day is over and after dinner it’s down time until a call comes in. And one does: a fall injury. Four firefighters are let in by a man to a disheveled apartment and find a woman on the floor. One of her legs is wrapped in a bloody elastic bandage. And she is drunk. “She’s laughing and joking and moving her leg around,” Welander says.
The responders learn that the woman fell down and heard a pop. As they examine the injury, they find indications of a compound fracture of her tibia and fibula, both of which are poking through her skin.
The crew calls for a paramedic unit, which helps with treatment and drives her to the hospital. Detail matters when calling 911 regarding a medical emergency. Because the call about the woman was for a fall injury with no more detail, EMTs were sent first to assess the situation. Had someone mentioned broken bones that broke skin, says Welander, a paramedic unit might have been called out first.
“The caller needs to describe the scene as accurately as possible,” says Herrera, “and the dispatcher will make a determination of who to send.”
Mental health calls are some of the most challenging because the emergency health system isn’t set up to handle them. It’s clear that someone who has overdosed or done physical harm needs to go to an ER.
“But if someone has high anxiety or is very angry, it’s not necessarily true that the emergency room would be able to give the most help,” Herrera says.
Paramedics can drive patients only to ERs, so a crisis center is an extra ride away.
“We don’t want to just leave (patients) where they are because they need help,” he says, “so the emergency room has always kind of been the fallback.”
Before Welander’s shift is over, he and his crew tends to a man whose bug bite five days earlier is still swollen, itchy and tender to the touch. The EMTs recommend he take a pain reliever, use an anti-bacterial cream and visit urgent care if it gets worse.
Welander says he “loves his job” as a Station 4 firefighter. It’s the home of TFD’s technical rescue technicians (TRT) team. It responds to complex situations such as structural collapse, swift-water rescue, automobile extraction, rope rescue and confined-space rescue.
Firefighters rely on their training as a well-oiled unit to handle these calls. “You feel like you’re part of a Super Bowl team,” Welander says. “Say you pull someone out of a mangled car. That’s an awesome feeling. It’s great anytime we go on a real call.”
But frequent calls from one location for issues that are not medical emergencies “wears on you,” he adds.
There are many stories of these types of calls: People who are homeless and want to get out of extreme weather; the poor who can’t afford to see a doctor or urgent care; the person who frequently calls 911 for non-emergencies.
Many 911 calls can’t be solved by emergency medicine: a drug addict who wants to get clean, an elderly woman who needs help with every-day tasks.
“Many times people call 911 because they are at a loss on what to do or how to solve their problem,” says Herrera.
This frequent over-use and abuse of 911 causes “compassion-fatigue” among firefighters, says Capt. Brian Thompson.
“It’s one of those things when you’ve seen the same person out in the field three or four times and they are not taking the steps needed to make progress,” says Thompson. “Our crews are feeling it.”
To help these frequent callers and reduce the number of non-emergency calls, TFD implemented a program designed by Assistant Chief Sharon McDonough. The Tucson Collaborative Community Care (TC-3) program started in January 2016. Thompson is its team manager.
Four firefighters in the program take referrals from field crews who feel a person could benefit from the program. It also takes referrals from a database that tracks frequent 911 callers.
A TFD crew had to rescue a man who had fallen in his bathroom, Thompson reports. The crew, seeing his home in major disrepair, referred his case to the TC-3 team. As the man recovered in a skilled nursing facility, he got a visit from the team, which discovered that he also didn’t have transportation to buy groceries.
The team called the non-profit Community Home Repair Projects of Arizona to fix the water heater and evaporative cooler. Workers also installed a new bathroom sink to replace the one damaged during the rescue. TC-3 also made arrangements for a grocery store to make home deliveries.
“When he returned home, things were much better than when he left,” Thompson says. “This gentleman has been able to enjoy his family home and a better quality of life.”
TC-3 works with many agencies such as Pima Council on Aging, El Rio Community Health Center, Interfaith Community Services, Salvation Army and Sister Jose, as well as private companies that offer home health, hospice care and other services. They help TC-3 coordinate care that will reduce emergencies and, subsequently, 911 calls.
“The city of Tucson has a wide range of valuable resources,” Thompson says. “TC-3 navigates these individuals to the appropriate resources that fit their needs. It is then that we see a reduction, if not a complete stop, to the 911 super-utilization.”